Relapse or failed treatment
This section gives guidance on treatment for patients whose infection has relapsed or whose treatment has failed.
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IFN and ribavirin
Retreatment with a combination of pegylated IFN and ribavirin is effective in patients with CHC who have had unsuccessful treatment with non-pegylated IFN with or without ribavirin, and leads to sustained viral response in a proportion of patients. The SVR is highest in patients who had received prior treatment with non-pegylated IFN monotherapy, those infected with genotypes 2 or 3, those who had relapsed rather than not responded to previous treatment, and those who were not cirrhotic at time of retreatment.166 3
Patients with CHC who have had unsuccessful treatment with non-pegylated IFN and ribavirin should be considered for pegylated IFN and ribavirin retreatment.
Other therapies
Meta-analysis of three studies of viral relapsers after IFN based treatment (304 patients) found no significant increase in SVR with the addition of amantadine to IFN plus ribavirin therapy.167 Non-responders to IFN based treatment showed a significant increase in SVR (12.7%, 95% CI 3.8-21.6%) with the addition of amantadine to IFN plus ribavirin therapy.167 1-
Three open label studies of IFN and ribavirin plus amantadine for the retreatment of nonresponders to IFN based treatment found an SVR rate between zero and ten per cent.168 In another small study the addition of amantadine to pegylated IFN and ribavirin did not lead to an increase in the SVR or biochemical response.169 1+
IFN in combination with ribavirin is superior to IFN in combination with amantadine.168 1+
A small randomised placebo controlled trial demonstrated that 48 weeks of ribavirin monotherapy is not superior to placebo with regard to HCV RNA levels or histological change in patients who are non-responders to standard IFN and ribavirin therapy.170 1+
In patients with chronic hepatitis C who did not respond to previous therapy, interleukin 12 (500 mg/kg twice weekly for eight weeks) was shown to produce a sustained viral response in one per cent of patients and severe adverse reactions in three per cent.171 2+
The following therapies are not recommended for the treatment of patients infected with CHC, whether they are being treated for the first time, previously relapsed, or have never responded to treatment:
- amantadine in addition to pegylated IFN alone or in combination with ribavirin
- ribavirin monotherapy
- interleukin 12.
